Postdural puncture headache: Diagnosis, prevention and therapy

Lumbar puncture (LP) is a routine technique performed for a variety of proc edures, e.g. diagnosis, administration of drugs, myelography and spinal ana esthesia. Postdural puncture headache is a common complication (30-40% in d iagnostic LP). Prevention can be accomplished by using small-gauge needles (less than or equal to 25 G) or pencil-point needles (22 G). Therapy should be carried out in a stepwise approach. The first step is bedrest, use of a nalgetics, i.v. fluids and an adequate guidance of the patient. The second step comprises special drug therapy. Several methods of pharmaco logic management have been presented in the literature, but most of these a re case reports. There is a lack of large double-blind placebo-controlled s tudies. Theophylline, caffeine, ACTH and sumatriptan are potentially promis ing agents for the treatment of postdural puncture headache. The efficacy o f theophylline has been proven in a double-blind and placebo-controlled stu dy. There are a few studies and case reports reporting that caffeine p.o. a nd i.v, is effective in the treatment of postdural puncture headache, but r ecurrence of headache after caffeine therapy is frequent. ACTH acts on a co mplex hormonal system. The treatment with sumatriptan has been reported in only a few case reports The third step, and one of the most effective treat ments of postdural puncture headache, is the epidural blood patch. The succ ess rate ranges between 80 and 97%.